This invited editorial introduces a special issue of Epidemiology & Infection while also discussing advances in emerging infectious diseases.

Background

The purpose of this study was to identify global trends in Listeria monocytogenes epidemiology using ProMED reports. ProMED is a publicly available, global outbreak reporting system that uses both informal and formal sources. In the context of Listeria, ProMED reports on atypical findings such as higher than average case counts, events from unusual sources, and multinational outbreaks.

Methods

Keywords "Listeria" and "listeriosis" were utilized in the ProMED search engine covering the years 1996-2018. Issue date, countries involved, source, suspected and confirmed case counts, and fatalities were extracted. Data unique to each event, including commentary by content experts, were evaluated. When multiple reports regarding the same outbreak or recall were obtained, the last report pertaining to that outbreak was utilized. Rates of Listeria events over time were compared using a normal approximation to the Poisson distribution; p <  0.05 was considered to be statistically significant.

Results

From 1996 through 2018, 123 Listeria events were identified in the ProMED database. Eighty-one events (65%) were associated with two or more human cases (outbreak events), 13 events (11%) were associated with only one human case (sporadic cases), and 29 events (24%) were precautionary food product recalls due to the presence of bacterial contamination without associated human cases. The implicated food vehicle was identified in 69 (85%) outbreak events and in 10 (77%) sporadic case events. Listeria contaminated foods were identified in all precautionary recall events. Overall, 28 events (23%) implicated novel food vehicles/sources. Events associated with novel food vehicles increased over the study period (p <  0.02), as did international events with more than one country involved (p <  0.02). Ten reports (8%) described hospital-acquired events.

Conclusions

This study demonstrates the use of publicly available data to document Listeria epidemiological trends, particularly in settings where foodborne disease surveillance is weak or non-existent. Over the last decade, an increasing number of events have been associated with foods not traditionally recognized as vehicles for Listeria transmission, and a rise in international events was noted. Informing high-risk individuals such as pregnant women and immunocompromised individuals of safe food handling practices is warranted. To ensure timely recall of contaminated food products, open data sharing and communication across borders is critical. Changes in food production and distribution, and improved diagnostics may have contributed to the observed changes.

Background

The United Nations Refugee Agency (UNHCR) estimates the number of forcibly displaced people increased from 22.7 million people in 1996 to 67.7 million people in 2016. Human mobility is associated with the introduction of infectious disease pathogens. The aim of this study was to describe the range of pathogens in forcibly displaced populations over time using an informal event monitoring system.

Methods

We conducted a retrospective analysis of ProMED, a digital disease monitoring system, to identify reports of outbreak events involving forcibly displaced populations between 1996 and 2016. Number of outbreak events per year was tabulated. Each record was assessed to determine outbreak location, pathogen, origin of persons implicated in the outbreak, and suspected versus confirmed case counts.

Results

One hundred twenty-eight independent outbreak events involving forcibly displaced populations were identified. Over 840,000 confirmed or suspected cases of infectious diseases such as measles, cholera, cutaneous leishmaniasis, dengue, and others were reported in 48 destination countries/territories. The average rate of outbreak events concerning forcibly displaced persons per total number of reports published on ProMED per year increased over time. The majority of outbreak events (63%) were due to acquisition of disease in the destination country.

Conclusion

This study found that reports of outbreak events involving forcibly displaced populations have increased in ProMED. The events and outbreaks detected in this retrospective review underscore the importance of capturing displaced populations in surveillance systems for rapid detection and response.

Hepatitis E virus is a common cause of acute viral hepatitis. We analyzed reports of hepatitis E outbreaks among forcibly displaced populations in sub-Saharan Africa during 2010-2020. Twelve independent outbreaks occurred, and >30,000 cases were reported. Transmission was attributed to poor sanitation and overcrowding.

Infectious disease outbreaks play an important role in global morbidity and mortality. Real-time epidemic forecasting provides an opportunity to predict geographic disease spread as well as case counts to better inform public health interventions when outbreaks occur. Challenges and recent advances in predictive modeling are discussed here. We identified data needs in the areas of epidemic surveillance, mobility, host and environmental susceptibility, pathogen transmissibility, population density, and healthcare capacity. Constraints in standardized case definitions and timely data sharing can limit the precision of predictive models. Resource-limited settings present particular challenges for accurate epidemic forecasting due to the lack of granular data available. Incorporating novel data streams into modeling efforts is an important consideration for the future as technology penetration continues to improve on a global level. Recent advances in machine-learning, increased collaboration between modelers, the use of stochastic semi-mechanistic models, real-time digital disease surveillance data, and open data sharing provide opportunities for refining forecasts for future epidemics. Epidemic forecasting using predictive modeling is an important tool for outbreak preparedness and response efforts. Despite the presence of some data gaps at present, opportunities and advancements in innovative data streams provide additional support for modeling future epidemics.

Background

Media reporting on communicable diseases has been demonstrated to affect the perception of the public. Communicable disease reporting related to foreign-born persons has not yet been evaluated.

Objective

Examine how political leaning in the media affects reporting on tuberculosis (TB) in foreign-born persons.

Methods

HealthMap, a digital surveillance platform that aggregates news sources on global infectious diseases, was used. Data was queried for media reports from the U.S. between 2011-2019, containing the term "TB" or "tuberculosis" and "foreign born", "refugee (s)," or "im (migrants)." Reports were reviewed to exclude duplicates and non-human cases. Each media source was rated using two independent media bias indicators to assess political leaning. Forty-six non-tuberculosis reports were randomly sampled and evaluated as a control. Two independent reviewers performed sentiment analysis on each report.

Results

Of 891 TB-associated reports in the US, 46 referenced foreign-born individuals, and were included in this analysis. 60.9% (28) of reports were published in right-leaning news media and 6.5% (3) of reports in left-leaning media, while 39.1% (18) of the control group reports were published in left- leaning media and 10.9% (5) in right-leaning media (p < .001). 43% (20) of all study reports were posted in 2016. Sentiment analysis revealed that right-leaning reports often portrayed foreign-born persons negatively.

Conclusion

Preliminary data from this pilot suggest that political leaning may affect reporting on TB in US foreign-born populations. Right-leaning news organizations produced the most reports on TB, and the majority of these reports portrayed foreign-born persons negatively. In addition, the control group comprised of non-TB, non-foreign born reports on communicable diseases featured a higher percentage of left-leaning news outlets, suggesting that reporting on TB in foreign-born individuals may be of greater interest to right-leaning outlets. Further investigation both in the U.S. and globally is needed.

Background

Multidisciplinary and multisectoral approaches such as One Health and related concepts (e.g., Planetary Health, EcoHealth) offer opportunities for synergistic expertise to address complex health threats. The connections between humans, animals, and the environment necessitate collaboration among sectors to comprehensively understand and reduce risks and consequences on health and wellbeing. One Health approaches are increasingly emphasized for national and international plans and strategies related to zoonotic diseases, food safety, antimicrobial resistance, and climate change, but to date, the possible applications in clinical practice and benefits impacting human health are largely missing.

Methods

In 2018 the "Application of the One Health Approach to Global Health Centers" conference held at the Albert Einstein College of Medicine convened experts involved in One Health policy and practice. The conference examined issues relevant to One Health approaches, sharing examples of challenges and successes to guide application to medical school curricula and clinical practice for human health. This paper presents a synthesis of conference proceedings, framed around objectives identified from presentations and audience feedback.

Findings and recommendations

The following objectives provide opportunities for One Health involvement and benefits for medical schools and global health centers by: 1) Improving One Health resource sharing in global health and medical education; 2) Creating pathways for information flow in clinical medicine and global health practice; 3) Developing innovative partnerships for improved health sector outcomes; and 4) Informing and empowering health through public outreach. These objectives can leverage existing resources to deliver value to additional settings and stakeholders through resource efficiency, more holistic and effective service delivery, and greater ability to manage determinants of poor health status. We encourage medical and global health educators, practitioners, and students to explore entry points where One Health can add value to their work from local to global scale.

Unusually large outbreaks of mumps across the United States in 2016 and 2017 raised questions about the extent of mumps circulation and the relationship between these and prior outbreaks. We paired epidemiological data from public health investigations with analysis of mumps virus whole genome sequences from 201 infected individuals, focusing on Massachusetts university communities. Our analysis suggests continuous, undetected circulation of mumps locally and nationally, including multiple independent introductions into Massachusetts and into individual communities. Despite the presence of these multiple mumps virus lineages, the genomic data show that one lineage has dominated in the US since at least 2006. Widespread transmission was surprising given high vaccination rates, but we found no genetic evidence that variants arising during this outbreak contributed to vaccine escape. Viral genomic data allowed us to reconstruct mumps transmission links not evident from epidemiological data or standard single-gene surveillance efforts and also revealed connections between apparently unrelated mumps outbreaks.